Team Name: ______ Coach/Manager Name:

Contact Person:Contact Number:______

Fax Number:E-Mail:

Mailing Address:

Team Roster and Waiver

In consideration of being allowed to participate in any way in the Yukon Indian Hockey Association’s athletic/sports program, related events and activities, the undersigned acknowledges and agrees that:

  1. The risk of injury from the activities involved in the event are significant, including the potential for permanent paralysis and death, while particular rules, equipment and personal discipline may reduce this risk of serious injury does exist;
  2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, even if arising from the negligence of the releases or others, and assume full responsibility for my participation;
  3. I willingly agree to comply with the stated and customary terms and conditions for participation. If I observe any unusual hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately;
  4. I, for myself and on behalf of my heir, assigns, personal representatives and next of kin, HEREBY RELEASE THE YUKON INDIAN HOCKEY ASSOCIATION, their officers, officials, agents and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of the premises used to conduct the event (“Releasees”), with respect to any and all injury, disability, death, or loss or damage to person or property, whether caused by the negligence of the releasees or otherwise; and
  5. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY INDEMINFY AND HOLD HARMLESS all the above Releasees from any and all liabilities to my involvement or participation in this event.
  6. Picture/Video Graphing - Release Authorization

By signing the waiver for the undersigned, I do hereby consent and agree that the pictures & Videos taken of players will be used by the Yukon Indian Hockey Association for purposes in publications or other visual processes. The Yukon Indian Hockey Association reserves the right to have the final selection of which pictures/Videos will be used. I understand that my involvement in this activity does not guarantee that my picture(s) or Videos will be used.

“C” DIVISION ENTRY FORM – 2018: Page 1/2

TEAM NAME ______“C” DIVISION ENTRY FORM 2018: Page 2/2

I read this Release of Reliability and Assumption of Risk Agreement, fully understand its terms, understand that I have given up substantial rights by signing it, and sign it freely and voluntarily without any inducement.

First Nation or Inuit
Player’s Full Name / Status Card # or
Attach FN Letter
(MANDATORY) / Date of Birth (REQUIRED)
(YYYY/MO/DD) / Signature of Player or Consenting Parent
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
Non-Native
Player’s Full Name
/ Date of Birth
(REQUIRED) / Signature of Player or Consenting Parent
1.
2.
Goalie’sFull Name
/ Please indicate if goalie is Native or Non-Native / Date of Birth
(REQUIRED) / Signature of Player or Consenting Parent
1.
2.

Proof of Ancestry: all First Nation and Inuit hockey players must provide a copy of Proof of Ancestry. Proof of Ancestry includes the following:

  • a Status or Treaty Card;
  • a certified Nunavut Trust card, roll number or any other proof accepted by Inuit communities; or
  • official letter from First Nation indicating that you are a member.
  • Metis Hockey Players: All Metis hockey players must submit a Metis Player Application Form along with an official letter from a recognized Metis organization to the Yukon Indian Hockey Association by Friday, March 9th, 2018. The Yukon Indian Hockey Association will approve or deny the Metis Player Application form based upon the information provided. Form can be found at

Applicant Information

Full Name:______

Date of Birth (YYYY/MO/DD): ______Male Female

Full Mailing Address:______

Daytime Phone:______

Evening Phone:______

Declaration of Ancestry

This part of the must be completed by the First Nation or Inuit Organization.

Full Name of First Nation or Inuit Organization:______

______

Full Address of First Nation Or Inuit Organization:______

______

Contact Person (Full Name):______

Phone Number:______

Fax Number:______

Registry Number:______

Region:______

I, ______, the register/status services representative for the

(Full Name of Register/Status Services Representative)

______, here by declare that ______

(Full Name First Nation) (Full Name of applicant)

is a member or descendant of our First Nation. I hereby declare that the information provided in this statement is true to my knowledge and will be held responsible for any conflicts arising from this declaration.

______

Signature of First Nation Register/Status Services Representative